Mr. Noel Smith (Hansard, 18 February 1998)

§ Mr. Eddie O'Hara (Knowsley, South)

I wish to draw to the House's attention the case of a life that has been grievously damaged as a result of treatment by the health services, mostly under the national health service. There has been no redress to that damage, and no one has yet been prepared to take responsibility for it.

Noel Frank Smith, a constituent of mine, was born in Liverpool on Christmas day 1922—Noel was a Christmas baby. At an early stage, he suffered rheumatic fever, and in 1929, at the age of six, he was admitted to Myrtle Street children's hospital. On examination by a specialist cardiologist, a disorder of the heart was diagnosed— mitral valve disease. The prognosis was that he was unlikely to live beyond his teens, and he was told to avoid strenuous exercise.

The prognosis had drastic consequences for the rest of his life. He could not lead the life of a normal child, and had regularly to visit to his general practitioner, who prescribed glyceryl trinitrate, a vasodilator designed to decrease his blood pressure to prevent strain being put on the supposedly defective valve in his heart.

Mr. Smith's job prospects and earning capacity were curtailed. There was less sympathy and provision for chronic invalids in those days. In short, his quality and standard of life have been affected, as has provision for his old age. Worse still, his painful treatment has had lasting side effects. He now suffers from degeneration of the cell walls around his veins. To put it in his words, his blood vessels are now like a leaky boat. He suffers much discomfort and pain as a result of the pooling of fluids in his legs. He has also developed glaucoma, which he maintains is because his eyes have reacted to his treatment in the same way as the rest of his vascular system. After his initial diagnosis in 1929, Mr. Smith did not see another heart specialist until 1981, when he attended Broadgreen hospital in Liverpool with a chest infection. After tests, he was advised that he did not have a heart complaint, and that the diagnosis of mitral heart disease made 52 years previously had been wrong. His understandable reaction was to instruct a solicitor to prepare a claim against the cardiologist who had made the false diagnosis. However, he was given counsel's opinion that there was no evidence of negligence, and therefore no ground for a claim.

Mr. Smith subsequently received a second and contrary opinion based on a number of points, including the fact that, when the misdiagnosis was first discovered, the lasting damage to his health was not clear or known, and that he had not been examined by a cardiologist in the 52 years between the initial diagnosis in 1929 and the second opinion in 1981. I ask the House to consider 52 years of repeat prescriptions for serious drugs for a supposed heart disorder.

However, there was an obstacle to Mr. Smith's pursuit of a claim for compensation: he had no access to his medical records. His battle for access to his records was conducted first by Eddie Loyden, the Member of Parliament in whose constituency of Garsden he lived when the misdiagnosis was discovered, and thereafter, when he went to live in Knowsley, by my predecessor, the late Sean Hughes. The matter had not been resolved when I entered Parliament in 1990 and picked up the case.

1060 There were three aspects to the story of Mr. Smith's records. First, in 1983, shortly after the discovery of the misdiagnosis, the medical records mysteriously disappeared. They were withdrawn by the medical practitioners unit at Princes road, Liverpool, and mysteriously went to Hertfordshire. A strange story was told about someone registering and claiming benefit, fraudulently using Mr. Smith's national insurance number. It was not until 1985 that the records eventually returned. Secondly, there was the battle to gain access to the medical records. That was pursued, but when Mr. Smith eventually gained access to them, key sections were missing. The whole story is mysterious and sinister.

The third aspect, in which I have been most involved, is trying to get to the bottom of what happened to the missing records. I pursued the complaint as far as the health service commissioner in 1996. His response was interesting. He gave three reasons for being unable to help: first, that the complaint was out of time—of course it was out of time by now, given that Mr. Smith had been battling steadily throughout the intervening time; secondly, that he could not become involved because of the possibility of legal action arising from the case; and, thirdly, that there was little practical point, after such a lapse of time, in trying to get to the bottom of how the records had mysteriously disappeared. And that was that.

There is yet another cruel twist to the tale. With or without his medical records, Mr. Smith does not have the means to pursue a claim without legal aid. That has been denied, not least because, after the long battle to get hold of his records, deficient as they are, the claim is statute barred, so he cannot have legal aid. The battle for Mr. Smith's right to pursue his claim through the law courts is a sub-plot with which I shall not burden the Under-Secretary of State for Health, my hon. Friend the Member for Brent, South (Mr. Boateng), but it is a subject for a whole Adjournment debate. Suffice to say that it has not yet been resolved.

One can choose the best cliche to describe Mr. Smith's experience: catch-22; Greek tragedy; or Kafkaesque. It is a catch-22 in that he could not pursue his case without his records, but by the time be got them he was statute barred. It is a Greek tragedy in that Mr. Smith has suffered a rare misfortune on a epic scale, and his twists and turns to alleviate his fate have been doomed to constant and, by now to me, predictable failure, given all the avenues that I have pursued on his behalf. There is no catharsis or relief in this drama because this is not vicarious drama; it is a real life ruined. It is Kafkaesque in that Mr. Smith has been shunted in bureaucratic circles, with functionaries who refer to and reinforce each other but do not address the issue—the ruin of Mr. Smith's life.

One could not blame Mr. Smith for concluding that the whole bureaucratic edifice is designed to serve itself and so thwart the individual. I hold what I thought was a common-sense view: that, if no one in the system will accept responsibility for the wrong done to Mr. Smith, the ultimate responsibility rests with the Secretary of State; but successive Secretaries of State have declined to acknowledge that.

I leave the last word to Mr. Smith: the Ministers did answer your letters and mine but…they never acknowledged the questions that we asked. I would have thought that being responsible Ministers they would have sent a directive to Merseyside Regional Health Authority to get the problem of my missing medical records sorted. Also, 1061 that they would inform me why I was treated for the serious heart complaint that I was mistakenly diagnosed as suffering from for 54 years of my life and also the drastic medical treatment that has caused me so much pain and injury. I know that I am entitled to an explanation and answer to these questions. I also know that I am entitled to compensation for the pain and injury that I am suffering to this day. I am pleased to have a Minister at the Dispatch Box to respond to the debate. He is a sympathetic Minister, and I hold him in high regard. I realise that he is only the most recent of a succession of Ministers who have been approached about this case. I look forward at least to a positive and sympathetic response to this exceptional story of a ruined life, but I urge him to institute an inquiry into this sorry matter.

§ The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng)

The constituent of my hon. Friend the Member for Knowsley, South (Mr. O'Hara) is fortunate in only one respect: he has a hard-working and diligent Member of Parliament, who has pursued every avenue on his behalf. I congratulate my hon. Friend on securing this debate on behalf of Mr. Noel Smith.

Mr. Smith's experience over 70 years gives us considerable pause for thought and for regret. For most of his life, he has suffered pain and distress as a result of an inaccurate diagnosis that went undiscovered for more than half a century. His experience may be unique in its duration, and we can only express regret at his suffering.

The problem predates the national health service, whose 50th anniversary we celebrate this year. This story began at a time when people did not enjoy, as we all do now, a national health service that is capable of responding to the changes in people's expectations. Not to be registered with a family doctor and via him or her to have access to a comprehensive range of appropriate health care is almost inconceivable today, but Mr. Smith's story began at just such a time.

My hon. Friend raised this case with my right hon. Friend the Secretary of State last summer. The matter has been pursued through our predecessors and through other channels. When I replied to my hon. Friend's correspondence on 6 August 1997, I could do no more than repeat the message that he had received a number of times in the past. No mechanism is currently in place by which Mr. Smith can seek redress for the initial misdiagnosis and subsequent, apparently unnecessary, treatment that has dominated and ruined his life.

I am sure that, on reflection, my hon. Friend will appreciate that the NHS is not at fault. After all, it was at an NHS hospital, Broadgreen in Liverpool, that doctors revealed the truth to Mr. Smith in 1981. The national health service made known to its patient the enormity of what had happened to him.

That must have been a time of incredibly mixed emotions for Mr. Smith. He must have been relieved that he was not suffering from a condition that was likely considerably to truncate his life, but the knowledge that he had spent much of his childhood and all his adult life under the misconception that he was suffering from a potentially fatal disease must have been devastating. It was not until Mr. Smith attended hospital for treatment of a chest complaint that the enormity and horror of the situation was revealed.

1062 This is an astonishing state of affairs. Mr. Smith had been told that he was unlikely to survive beyond his teens. He was not examined thoroughly at any time until the age of 58. It would be surprising if, at some time during that period, it had not occurred to him that there was something wrong because the prognosis had not materialised. It is clear that, for whatever reason, he did not discuss the matter with his general practitioner, and no inquiries were made as to how it was that he was still in the land of the living. One hopes that such a total breakdown of communication between patient and the NHS would not happen today.

I have made inquiries about the medical notes, to which my hon. Friend rightly attaches considerable significance. Unfortunately, every attempt has been made to trace those notes, but without success. I understand that the Liverpool health authority has copious notes on a file dating back to July 1954, all of which Mr. Smith has seen for himself. He is concerned that entries may be missing, but no one can say for certain that they are.

Significantly, legislation governing the security of medical records and a patient's right of access is a comparatively recent development. The actions of the clinician working at a pre-NHS hospital in the 1920s, who is long since dead, are not covered by existing guidelines. It is Mr. Smith's misfortune to be in a unique position that is not covered by any known guideline or procedure.

We have no reason to believe that the original doctor acted in anything other than good faith, bearing in mind the extent of medical knowledge at the time and the rapid advances in treatment and diagnostic techniques that followed. I accept that successive GPs must have had access to some form of written record to persist with the treatment for more than 50 years. That was investigated by the old Liverpool family health services authority, which contacted all Mr. Smith's former GPs in 1992. The health service commissioner, who was unable at the time to investigate clinical decisions, found no suggestion of impropriety by the FHSA in the retention of or access to Mr. Smith's medical records.

I hope that my hon. Friend will find some reassurance in the knowledge that, if there were any way to remedy the situation, we would do so without delay. It gives me no satisfaction whatsoever to say that every possible method has been tried, and that no adequate solution has emerged.

I sincerely regret the unfulfilled years of Mr. Smith's life. I am glad that he is still with us, and that the early ill-founded and misplaced predictions were not fulfilled. I am pleased that he has lived to see the day when we can rely on accurate diagnosis and access for all to appropriate treatment as routine features of the modern NHS. Access to medical records is now the due entitlement of every patient.

My hon. Friend has pressed long and hard for justice for Mr. Noel Smith. I am sorry that the debate is unlikely to satisfy either of them. I express profound regret on behalf of the national health service. I would be only too happy, if it would assist in any way, to meet Mr. Noel Smith with my hon. Friend at the Department to express to him in person my sincere regrets and the regrets of the health service.